DE102005053994A1 - Diagnostic device for combined and / or combinable radiographic and nuclear medicine examinations and corresponding diagnostic method - Google Patents

Abstract

Digital imaging methods are now common in medical diagnostics. Such methods have been used for some time, e.g. B. used in computed tomography, magnetic resonance examinations, ultrasound examinations and procedures in nuclear medicine. DOLLAR A The invention is based on the object of proposing a diagnostic device and a corresponding method which open up new application possibilities for the treating physicians. DOLLAR A For this purpose, a diagnostic device (1) for combined and / or combinable radiographic and nuclear medicine examinations with an X-ray source (9), with an examination room for receiving a patient (5) with a gamma radiation source (6) arranged in the body, is proposed (1) is designed to carry out the radiographic examination by evaluating the measurement of the X-ray radiation and to carry out a single photon emission (SPE) examination by evaluating the gamma radiation as a nuclear medicine examination, with a detector system (8a, b, 10) which has a detector surface for simultaneous measurement of the X-ray and gamma radiation without changing the patient's position and / or which is designed to record a two-dimensional, spatially resolved and objectively imaging single X-ray projection image.

Description

The The invention relates to a diagnostic device for combined and / or combinable radiographic and nuclear medicine examinations with a X-ray source, with an examination room for receiving a patient with a in the body arranged gamma radiation source, wherein the diagnostic device is designed to by evaluating the measurement of the X-ray radiation perform the radiographic examination and order by evaluation gamma radiation as a nuclear medicine study a single-photon emission (SPE) investigation.

digital Imaging procedures are now common in medical diagnostics. such Methods have been used for some time, e.g. in computed tomography, in magnetic resonance examinations, ultrasound examinations and used in nuclear medicine procedures.

In In recent years nuclear medicine has become so called SPELT (single photon emission computer tomographs) enforced diagnostic devices, which enable a functional imaging. Basis of the method is a tracer principle with radioactive substances. It is through Addition of very small amounts of a radiolabeled compound into the object to be checked its metabolism by measuring the radioactive radiation of Outside, thus not invasive, observed. The marked tracer accumulates in certain organs or tumors or metastases and allowed thus a good diagnosis of the metabolism, the finding of tumors and metastases or even an assessment of perfusion of the heart muscle. The SPELT uses radionuclides (isotopes), which are used under Emission of a single gamma quantum decay. Used tracers at SPECT are e.g. For Bone Scintigraphy Tc99m-MDP (Tc = technetium), for myocard Perfusion TI-201 or Tc99m-MIBI or in thyroid tumors Iodine 131st Nuclear medicine imaging uses the tracer principle by: she takes pictures of the distribution of the radioactivity of a tracer. Usually is the radioactive radiation over Scintillation detectors detected.

The However, SPELT technique is not known to provide good anatomical Imaging such that the location of e.g. detected tumors or Metastases in the body the patient is problematic. To get better anatomical imaging too The patient may receive before or after the SPELT examination with a radiographic CT (computed tomography) or MRI (magnet Resonance imaging) system are examined. Then it turns the Challenge of correct registration, namely the recordings of the SPECT and the CT or MRI correctly overlay and to represent together. For this purpose, the image data in a common Transfer coordinate system, this process is also called "software based registration " are. Such methods are e.g. from US 2005/0027187 A1 or US Pat from the dissertation of Timo Mäelä with the Title "Data Registration and Fusion for Cardiac Applications "ISBN 951-22-6514 Such registration process is that they interactively carried out the investigations Need to become and that they have only limited accuracy.

The SPECT (Single Photon Emission Computer Tomography) - CT Diagnostic Device the applicant Siemens AG, Erlangen, Germany with the product name "Symbia", which is the closest State of the art forms, offers the possibility of nuclear medicine SPELT examinations and radiographic CT examinations successively, However, in a common apparatus to perform.

Out The document WO 2004/095069 A1 is a combined detector element Detection of X-ray and gamma radiation known. This detector element has a converter, the one charge signal in dependence of sunken X-ray or gamma quantum generated. In a downstream evaluation device the charge signal is amplified and evaluated on two different branches, the first Branch a single-pulse analyzer to obtain information for a PET (Positron Emission Tomography), and the second branch a pulse sequence analyzer for the determination of information for a CT (Computer Tomography) having.

Of the Invention is based on the object, a diagnostic device and to propose a suitable procedure to inform the treating physician Physicians new applications open.

These The object is achieved with a device having the features of the claim 1 solved. Preferred or advantageous embodiments are given by the following Description and the features of the subclaims given.

The Inventive diagnostic device for one Combined and / or combinable radiographic and nuclear medicine Investigated examination, the radiographic examination in particular as an X-ray projection examination is trained. Preferably, both the evaluations of the radiographic and nuclear medicine examinations digital imaging techniques.

The Diagnostic device comprises an X-ray source, the X-radiation generated for examination purposes on the human body. Is preferred the X-ray source as an X-ray tube, preferably with x-ray voltages from 120 to 150 kV, in particular X-ray quanta generated with energy of about 100 keV.

Farther An examination room is provided for the admission of a patient serves. For the Nuclear medical examination will be given to the patient before the examination in the body radioactive substances (tracers) with the help of adequate radiopharmaceuticals in the placed to be examined tissue / organ. These radiopharmaceuticals or The radioactive substances emit gamma radiation (high energy Photons). For example, those mentioned in the introduction Radiopharmaceuticals used.

The Energies of the X-ray quanta the X-ray source and the energies of the gamma quanta are preferably in a similar one Energy range in particular from 80 to 160 keV and are thus physically similar Nature. For the sake of distinction, reference is made within this application the expressions X-rays, X-ray quanta etc., however, always on photons generated in the X-ray source and the expressions Gamma rays, gamma quanta etc. always on photons emitted by the in the body the patient placed radioactive material (tracer) emitted become.

To the One is the diagnostic device designed to be a classic Radiographic examination, so in particular a X-ray projection medical To perform an examination on the patient. On the other hand, the diagnostic device is designed for a nuclear medicine single photon emission (SPE) investigation to perform on the patient. In the known single photon emission (SPE) investigation Be the ones in the body gamma quanta emitted by the patient an integrating measurement detected.

The Diagnostic device comprises a detector system, which according to the first Invention alternative for the simultaneous measurement of X-ray and gamma radiation is trained. With one and the same detector system, in particular with one and the same detector elements, are the X-ray and gamma quanta detectable. Preferably, the detector system has a flat detection surface and / or a slightly curved one Detection area with a radius of curvature greater than the multiple, in particular larger than three times the distance between the detection system and the center of the examination room In particular, the measuring space of the detector system, the examination room without overlapping just pervades. In particular, the detection system no detector arrangement, which for a PET (positron emission Tomography) - investigation suitable is.

at the second alternative of the invention is provided that the or a detector system for the radiographic examination for taking a two-dimensional spatially resolved and representational X-ray projection frame is trained. In contrast to the known CT devices, the above a detector array with one or more line sensors have points the detector system according to the invention For example, a flat detector, which is a two-dimensional recording allowed.

Of the Invention is based on the idea by adapting the system technology the system required room for to reduce the diagnostic device. This is the first invention alternative to reduce the space requirement by saving on detectors. In the second alternative, instead of the radiographic CT one on x-ray projection images based investigation carried out and in this way especially the space-consuming ring construction (gantry) for recording and fast rotation of the detector and the X-ray source saved by the patient. Both invention alternatives have thus the advantage that the patient easier during the examination accessible is. Thus, the foundation is laid, the patient in the diagnostic device not only to examine, but also to treat.

moreover It is advantageous that the diagnostic device, although all necessary Contains elements of an SPE device and an X-ray device, but a variety of components, such as e.g. Image computer, image and data memory, DICOM data network Interface, patient table, multiple uses and thus compared with two individual devices cheaper is.

The The first alternative of the invention additionally offers the advantage that radiographic and nuclear medicine examination without change patient situation at the same position and thus a common measurement coordinate system is used. A subsequent Coordinate transformation for superposition of the Measurement results (fusion) of nuclear medicine and radiographic Examination is not necessary as the common measuring position provides a "hardware based registration".

Preferably, the detector system is designed as a flat detector with a sensor matrix and / or pixel matrix or comprises this. In particular, it is provided that a plurality of sensors / pixels a common readout channel and / or a associated with common analog-to-digital converter.

at a preferred embodiment the flat detector comprises a readout matrix, in particular a TFT matrix, in front of which a converter is connected, which is an incident high-energy photon, ie an x-ray or a gamma quantum, in an electric charge or in a low-energy light pulse implements. In particular, the converter is designed as a scintillator.

Around Artifacts and incorrect measurements can be avoided in particular as a stray radiation filter an optional collimator may be provided as a directional filter for the high-energy photons, so the X-ray and gamma quanta formed is. Preferably, photons that are perpendicular to a direction of movement or substantially perpendicular to a detector surface and / or to the converter having been transmitted by the collimator.

Conveniently, is over from the flat detector an adjustable or controllable integration time integrated Signal for each individual sensor and / or for each individual pixel can be output, wherein the individual sensors and / or the Individual pixels are designed in particular as integrating elements.

In a possible embodiment The diagnostic device sequentially has an SPE detector and a particularly separate X-ray detector. Preferably It is intended that a patient table be from both the SPE detector side as also from the X-ray detector side retractable is.

at A preferred embodiment is the diagnostic device for the creation of 3D soft tissue acquisition under evaluation of the detected X-radiation educated. Preferably, the diagnostic device is considered a sequential one Combination of SPE detector and X-ray detector designed wherein the SPE detector in an andiographic X-ray diagnostic device involved in rotational angiography. Their revelations are recorded by referencing in the present description. In principle, the invention is also based on the idea of an anatomical Imaging (radiography) with functional diagnostics (SPE) too connect. The latter embodiment sees additional before, the functional diagnostics also by the radiography at least partly to perform. This path leads to a double identification of soft tissues, in particular of Metastases or tumors, making the review of registration especially easy to carry out is.

Conveniently, a control and evaluation device is provided, the various Operating modes supported in particular the isolated and / or combined and / or combinable use of SPE or SPECT or X-ray examination options. In particular, a module for data fusion of radiographic and nuclear medicine measurement data resulting in combined SPE / SPECT X-ray data sets. Preferably the data fusion takes place in real time.

at a preferred embodiment and in continuation of the inventive concept includes the diagnostic device an integrated tumor treatment device and / or device for minimally invasive patient treatment, the control technology is coupled to the control and evaluation device or are. Preferably, the tumor treatment device is a laser ablation device designed, in particular as in the article by C. Weigel et al .: "Percutaneous laser ablation of lung metastases ", The radiologist 5 - 2004, Pages 491 to 499, the disclosure of which by referencing is integrated into the present description. Alternatively it is the tumor treatment device as a radio frequency ablation device In particular, as described in the articles by Zhengium Liu et al .: "Radiofrequency Tumor Ablation ", AJR: 184, April 2005, pages 1347 to 1352, or by J. Min Lee et al .: "Comparison of Renal Ablation with Monopolar Radiofrequency and Hypertonic Saline Augmented Bipolar Radiofrequency: In Vitro and In Vivo Experimental Studies ", AJR: 184, March 2005, Pages 897 to 905 or by David W. Barker et al .: "Evaluation of Liver Metastases After Radiofrequency Ablation: Utility of 18F-FDG PET and PET / CT ", AJR: 184, April 2005, pages 1096 to 1102, their disclosures via referencing is integrated into the present description. Alternatively, the Tumor treatment device designed as Kryoablationsvorrichtung, in particular, as in the article by M. Beland et al .: "Percutaneous Cryoablation of Symptomatic Extra-abdominal Metastatic Disease: Preliminary Results "AJR: 184, March 2005, p 926-930, the disclosure of which by referencing in the present description is integrated. The referenced references refer in particular to features of the ablation devices and features of the corresponding procedures.

• – Bewegungssensorsystem mit mathematischen Bewegungsdetektor, der die Patientenbewegungen aus den Bildsignalen, insbesondere den Messsignalen der nuklearmedizinischen und/oder radiographischen Untersuchung ableitet, insbesondere wie in der US 2002/0163994 A1: "In-Line Correction of Patient Motion in Three – Dimensional Positron Emission Tomography" offenbart, deren Offenbarungsgehalt via Referenzierung in die vorliegende Beschreibung integriert wird.
• – Bewegungssensorsystem mit Sensor mit elektrischem Wirkprinzip.
• – Bewegungssensorsystem mit kapazitiven Wirkprinzip, insbesondere wie in der US 6,661,240 B1 : "Method and System for Capacitive Motion Sensing and Position Control" offenbart, deren Offenbarungsgehalt via Referenzierung in die vorliegende Beschreibung integriert wird.
• – Bewegungssensorsystem mit magnetischen Wirkprinzip, insbesondere wie in der US 5,752,513 : "Method and Apparatus for Determining Position of Object" offenbart, deren Offenbarungsgehalt via Referenzierung in die vorliegende Beschreibung integriert wird.
• – Bewegungssensorsystem mit akustischen Wirkprinzip, insbesondere wie in der EP 1 034 738 B1 : "Positioning Based on Ultrasonic Emission" offenbart, deren Offenbarungsgehalt via Referenzierung in die vorliegende Beschreibung integriert wird.
• – Bewegungssensorsystem mit optischen Wirkprinzip, z.B. durch Abtasten mit einem Laserstrahl oder mit optischer (insbesondere im sichtbaren Bereich arbeitender) oder im infraroten Bereich arbeitender Kamera, insbesondere wie in der US 2004/0100557 A1: "Optical Tracking System" offenbart, deren Offenbarungsgehalt via Referenzierung in die vorliegende Beschreibung integriert wird.

Optionally, a motion sensor system for detecting patient movements in the diagnostic device according to the invention is provided. Patient movements are preferably recorded during the examination and / or during a transitional period from nuclear medicine to radiographic examination and taken into account in the fusion of the measurement results. Preferably, the control and Auswerteeinrich tion on a module that is designed to control the motion sensor system and to correct the nuclear medical and / or radiographic measurement data based on the measured patient movements. The following embodiments are possible:

• Motion sensor system with a mathematical motion detector, which derives the patient movements from the image signals, in particular the measurement signals of the nuclear medicine and / or radiographic examination, in particular as described in US 2002/0163994 A1: "In-Line Correction of Patient Motion in Three-Dimensional Positron Emission Tomography "whose disclosure content is integrated by referencing in the present description.
• - Motion sensor system with sensor with electrical operating principle.
• - Motion sensor system with capacitive action principle, in particular as in the US 6,661,240 B1 : "Method and System for Capacitive Motion Sensing and Position Control" discloses, the disclosure of which is incorporated by referencing in the present description.
• - Motion sensor system with magnetic action principle, in particular as in the US 5,752,513 : "Method and Apparatus for Determining Position of Object", whose disclosure content is incorporated into the present description via referencing.
• - Motion sensor system with acoustic action principle, in particular as in the EP 1 034 738 B1 : "Positioning Based on Ultrasonic Emission", whose disclosure content is incorporated into the present description via referencing.
• Motion sensor system with optical effect principle, eg by scanning with a laser beam or with optical (in particular working in the visible range) or working in the infrared range camera, in particular as disclosed in US 2004/0100557 A1: "Optical Tracking System" whose disclosure content via referencing is integrated into the present description.

The Data from the motion sensor system will either be hardwired or wirelessly transmitted to the control and evaluation device.

at a particularly preferred embodiment the motion sensor system is implemented in RFID transponder technology and in particular equipped with an RFID receiver system. Preferably is provided that the RFID transmitter provided with an adhesive surface is similar to the patient and plaster is glued on. In particular, the RFID transmitter is a disposable item trained, which is disposed of after use.

to Detection of organ movements, e.g. Movements of the heart, of the ribcage and blood vessels are optional sensors for measuring the ECG, respiration or vascular pulsation available. The measurement results are preferably sent to the control and evaluation and forwarded during image reconstruction and / or data fusion, in particular, resulting artefacts, for example eliminated by "gating".

For example can use a chest band to eliminate respiratory artifacts be, which has sensors that absorb the breathing amplitude and / or frequency are formed. Another possibility is the calculation of the respiratory amplitude and / or frequency from the ECG signal, in particular from an envelope of the ECG signal. Complementary or Alternatively, the pulses of the vessels by evaluation of the ECG or the blood pressure curve determined.

to Movement of the patient through the measuring range of the detector system a feed system is preferably provided which an automatic Advance of the patient by the diagnostic device allows. In particular, the diagnostic device for synchronized control of Feed system and detector system formed.

at In a further development, the feed system has a position sensor on, which is designed to receive the advancing movement of the patient is and arranged for example in a movable examination table is. The data of the position sensor, in particular the movement data the patient and / or the examination table, are preferably passed on to the evaluation and control device and at the image reconstruction and / or data fusion considered.

at a preferred embodiment the diagnostic device is preferably in the evaluation and control device provided a calibration module, wherein the motion sensor system and / or the position sensor with respect to the spatial coordinates of the diagnostic device be calibrated.

It is advantageous if the X-ray source and / or detector system are arranged opposite to the end sections of a C-shaped bracket which is rotatable in such a way that the end sections describe circular paths around the patient arranged in the center of the circular paths. In one possible embodiment, the C-arm construction is received by an industrial robot, preferably with 5 degrees of freedom. Alternatively, X-ray source and detector be mounted on movable tripods, for example, mounted on the ceiling or the bottom of a rack or a treatment room, the tripods are preferably movable in three degrees of freedom. Such a recording is in the US 6,934,352 B2 : "Method and Apparatus and Computer Program Product for Determining Abort Criterion during Acquisition of 2D Images of a 3D Subject" discloses the disclosure of which is incorporated by reference in the present description.

at An advantageous development is the diagnostic device, in particular the evaluation and control device, designed so that measurement data nuclear medicine examination and radiographic examination offset in time and / or alternating from the detector system and / or the detectors are readable and / or be read. Especially the read out process is clocked and / or synchronized with the Control of the X-ray source educated. In this embodiment Is it possible, that the patient is at a diagnostic device with separate nuclear medicine and radiographic detectors without interruption from the SPE / SPELT scanner section in the x-ray section or is advanced oppositely.

To the Protection of the operating personnel are preferably radiation protection curtains or covers arranged on the diagnostic device.

The The object underlying the invention is also achieved by a method solved with the features of claim 15, which is the use of Device described above, in particular by performing a Soft tissue X-ray examination provides.

It should finally be noted that the described training of Diagnostic device with a tumor treatment device preferred is, however, other apparatus training for therapies in which one Anatomical and functional imaging with good accessibility necessary for the patient are also possible. For example can over nuclear medicine examination perfusion of the heart muscle be determined while maintaining an anatomical mapping over the radiographic examination of the corresponding coronary vessels and derived therefrom a corresponding balloon dilatation and the Introduce a stent or stem cells done. In these applications that would be Diagnostic device according to apparatus for carrying out the Treatment trained.

The Thus, particular advantages are achieved with the invention combined in the good anatomical imaging by the radiographic examination with functional imaging showing the metabolism through the nuclear medicine examination in a short time and can be fused with high registration accuracy, where also good accessibility to the patient, for example for a tumor therapy is given.

following Be exemplary embodiments of Invention with reference to figures closer explained. there demonstrate:

1 a first embodiment of a diagnostic device according to the invention in a schematic representation;

2 a second embodiment of a diagnostic device according to the invention in a block diagram;

3 a third embodiment of a diagnostic device according to the invention in a schematic representation;

4 an embodiment of a data fusion of an X-ray image with a SPELT recording;

5 Signal curves in a schematic representation for illustrating a clocked reading of the detector system of the embodiments 1 or 2 and

6 a schematic representation of a detector in 3 ,

each other corresponding parts are in each of the various figures with provide the same reference numerals.

The 1 shows a first embodiment of a diagnostic device according to the invention 1 in a schematic representation with the structure of an evaluation and control device 2 in block diagram.

The diagnostic device 1 includes a first measuring range 3 for recording SPE or SPECT images and a second measuring range 4 for taking x-rays. A patient 5 which was administered radiopharmaceuticals with radioactive material before the study, posing as a tracer 6 have accumulated in a tumor, is by means of a patient support in the form of a movable in the Z direction couch 7 for a first examination through the first measuring range 3 and then through or into the second measuring range 4 postponed.

The first measuring range 3 has an SPE or SPECT probe, which is available in the 1 as two opposing and aligned detector arrays 8a , b is formed. The detector arrays 8a , B each have a collimator, not shown, which operates for the gamma radiation emitted from the tracer as a directional filter and / or as a stray beam filter. The detector arrays 8a , b comprise a plurality of quantum detectors, which are formed as semiconductor detectors or photomultipliers with upstream scintillation and / or converter layer.

The second measuring range 4 has a radiation source 9 in the form of an X-ray source and an X-ray detector 10 for the detection of the radiation source 9 emitted X-rays. radiation source 9 and x-ray detector 10 are at the free end sections of a C-arm 11 Arranged over a tripod 12 with a frame 13 is movably connected, so by rotation of the C-arm 11 radiation source 9 and x-ray detector 10 in a circular path around the lying patient 5 can be led around.

Furthermore, there is an ablation catheter 14 provided for treatment in the in the diagnostic device 1 lying patients 5 can be introduced.

The evaluation and control device 2 is via a data bus 15 connected to a variety of modules, which are explained below:
The data bus 15 is with a control panel 16 connected, which has a first output for driving the X-ray detector 10 , a second output for driving the detector arrays 8a , b and a third output for driving a high voltage generator 17 for the supply of the radiation source 9 having.

The data bus 15 is also with an ablation device 18 connected to the ablation catheter 14 controls.

Starting from the detector arrays 8a , b performs another signal path via a SPE / SPECT preprocessing module (preprocessing) 19 to the data bus 15 , An appropriate signal path leads from the X-ray detector 10 via an X-ray and preprocessing module (pre-processing) 20 also to the data bus 15 ,

The data bus 15 is equipped with an image processing unit for SPE / SPECT images 21 and with an image processing unit for X-ray images 22 The data processing for the soft tissue X-ray images (DynaCT) also takes place in the latter.

To record patient movements during the exam is at the diagnostic device 1 a motion sensor system 23 provided, which via an interface 24 and a motion and gating processor 25 with the data bus 15 connected is. Further, on the patient 5 Physiological sensors may be attached via an interface 26 Signal data in a module for physiological signal processing 27 deliver. In particular, in the module 27 ECG, pulse, respiration and blood pressure data received and processed. The results of the signal processing and / or the signal data are from the module 27 in the data bus 15 fed.

In an image fusion and reconstruction unit 28 The SPE / SPECT data and the X-ray images / soft tissue X-ray images are combined and converted into a combined representation. To compensate for patient movement, physiological changes of the patient during the examination is an image correction unit 29 intended. In addition, there is a calibration unit 30 in the evaluation and control device 2 integrated.

The results of the investigation are in a display unit 31 represented on which, for example, on a monitor, the SPE / SPECT, X-ray images or combined images can be displayed. Furthermore, operating and control data for the diagnostic device 1 , in particular for the ablation device 18 be shown. A human-machine interface 32 Serves for manual operation of the diagnostic device 1 , in particular the SPE / SPECT, the X-ray system and the ablation device 18 , For further processing and documentation of the examination results and the course of treatment a DICOM interface is provided 33 for communicating with a network for transferring patient data and image data as well as image and data storage 34 intended. The diagnostic device 1 also includes power supply units 35 to supply the individual modules.

Typical examination protocols or workflows for the diagnostic device 1 in 1 are given below:

Workflow 1:

• Tracer injection into the patient 5
• Optional X-ray contrast agent injection into the patient 5
• X-ray (preferably soft tissue X-ray examination)
• SPECT examination (e.g., whole body)

Workflow 2:

• Tracer injection into the patient 5
• Optional X-ray contrast agent injection into the patient 5
• SPECT examination (e.g., whole body)
• X-ray (preferably soft tissue X-ray examination, especially in the SPECT examination as affected specific organ area)

Workflow 3 with minimally invasive Therapy:

• Tracer injection into the patient 5
• Optional X-ray contrast agent injection into the patient 5
• SPECT examination (e.g., whole body)
• X-ray (preferably soft tissue X-ray examination, especially in the SPECT examination as affected specific organ area)
• Insertion of the ablation catheter 14 under X-ray control ablation of the tumor tissue
• Review of the Ablation with x-rays

Workflow 4 with high-resolution preview and with minimally invasive Therapy:

• high resolution Pre-recording with CT or MRI (via the DICOM interface sent or received)
• Relocating the patient 5 into the diagnostic device 1
• Tracer injection into the patient 5
• Optional X-ray contrast agent injection into the patient 5
• SPECT examination (e.g., whole body)
• "Software based registration "and Fusion of the 3D preview (CT, MRI) with the SPELT recordings
• X-ray (preferably soft tissue X-ray examination, especially in the SPECT examination as affected specific organ area), but with lower resolution but more recent data as the preview
• Insertion of the ablation catheter 14 under X-ray control ablation of the tumor tissue
• Review of the Ablation with x-rays

The 2 shows in the upper part of a modified embodiment of the diagnostic device 1 in 1 , The diagnostic device 1* in 2 has an aperture 36 on, in deviation from the embodiment in 1 in front of the detector arrays 8a , b and the downstream radiation source 9 and the X-ray detector 10 is arranged. Both the first and the second measuring range 3 respectively. 4 are at the diagnostic device 1* on a common side of the aperture 36 , On the patient 5 is an RFID transponder patch 37 glued on, according to the enlargement in the lower part of the 2 from a plaster 38 or from one to the human skin on adhesive carrier material and the actual RFID transponder 39 consists. To locate the RFID transponder patch 37 and thus also the exact position and movement of the patient 5 is an RFID position sensor receiver 40 provided its measured values in the data bus 15 (see. 1 ) feeds.

The 3 shows a third embodiment of a diagnostic device according to the invention 1** that differ from the diagnostic device 1 in 1 This distinguishes the functions of detector arrays 8a , b ( 1 ) and X-ray detector 9 ( 1 ) in a common detector 41 united. The detector 41 can both from the radiation source 9 originating X-radiation as well as from the tracer 6 register the originating gamma radiation and thus carry out a simultaneous measurement with both types of radiation without changing the patient position. Preferably, the detector is 41 as Festkörperdetek tor, in particular formed with a flat or substantially planar or only slightly curved detector surface. The first and the second measuring range 3 respectively. 4 the diagnostic device 1 in 1 are at the diagnostic device 1** in 3 overlapping and / or congruent.

The 4 illustrates the data fusion of measurement data of a SPECT examination and an X-ray examination. On the left side of the 4 is a 2D section plane of a 3D X-ray soft tissue image 42 shown, in the middle is a SPECT image 43 of the same area in the body of the patient 5 shown. These two shots 42 and 43 are with a diagnostic device according to 1 . 2 or 3 been created. On the right side is a combined SPECT / X-ray soft tissue recording 44 presented the merged measurement data of the recordings 42 and 43 includes. The combination or fusion of the measurement data leads to a combined recording 44 , in the primary lung tumors 45 and secondary tumors and metastases 46 better and more clearly visible to the attending physician than in the non-fused recordings 42 respectively. 43 ,

The 5 illustrates a clocked reading of the various sensors in the diagnostic device 1 . 1* or 1** from 1 . 2 respectively. 3 , In the first line is the waveform A for reading the quantum detectors of the detector arrays 8a , b shown over time, wherein at a high signal level, the quantum detectors are read out. In the second line, the waveform B for reading the ECG and respiration is shown. The third line shows the signal curve C for the output of an x-ray pulse by the radiation source 9 , As from a comparison of the waveforms A and C is recognizable, the radiation source 9 activated only at times when the quantum detectors are not read out. In this way, erroneous measurements are avoided by the quantum detectors. The waveform D refers to the time course of the readout of the X-ray detector 10 , which is read in each case after an X-ray pulse. The reading of quantum detectors and X-ray detectors thus takes place alternately and not overlapping. Similarly, the detector can 41 in 3 are driven, wherein alternately measured data with respect to the gamma radiation and measured data with respect to the X-radiation are read out.

6 shows a schematic representation of the detector 41 in 3 , The detector 41 has a sensor or pixel matrix 47 in which a plurality of individual sensors or pixels are arranged in rows and columns. The top of the sensor or pixel matrix 47 forms the detector surface 48 hit by the photons to be measured. The sensor or pixel matrix 47 upstream is a converter 49 , which converts high-energy photons, ie X-rays or gamma quanta, into low-energy light pulses or electrical charges. The converter 49 is optional a collimator 50 upstream, which works as a directional filter or stray beam filter for the incident high-energy photons.

Claims (18)

Diagnostic device ( 1 . 1* . 1** ) for combined and / or combinable radiographic and nuclear medicine examinations on a patient ( 5 ), in whose body a gamma radiation source ( 6 ) is arranged with an X-ray source ( 9 ), wherein the diagnostic device ( 1 . 1* . 1** ) is designed to carry out the radiographic examination by evaluating the measurement of the X-ray radiation and to carry out a single-photon emission (SPE) examination by evaluating the gamma radiation as a nuclear medicine examination, characterized by a detector system ( 8a , b, 10 . 41 ), which has a detector surface ( 48 ) for the simultaneous measurement of the X-ray and the gamma radiation without changing the patient position and / or which for taking a two-dimensionally spatially resolved and objectively imaging X-ray projection single image ( 42 ) is trained. Diagnostic device ( 1 . 1* . 1** ) according to claim 1, characterized in that the detector system as flat detector ( 9 . 41 ) is formed with or comprises a sensor matrix and / or pixel matrix. Diagnostic device ( 1 . 1* . 1** ) according to claim 1 or 2, characterized in that the flat detector ( 9 . 41 ) as a readout matrix ( 47 ) with upstream converter ( 49 ) is formed, which converts an incident high-energy photon into an electric charge and / or in a low-energy light pulse. Diagnostic device ( 1 . 1* . 1** ) according to one of the preceding claims, characterized in that the detector system ( 8a , b, 10 . 41 ) a collimator ( 50 ), which is designed as a directional filter for high-energy photons, so that only high-energy photons in the direction of projection for the nuclear medicine examination and / or for the X-ray projection frame are transmitted. Diagnostic device ( 1 . 1* . 1** ) according to any one of the preceding claims, characterized in that the detector system comprises an SPE detector ( 8a (b) for nuclear medicine examination and an X-ray detector ( 10 ) for the radiographic examination, which are arranged sequentially. Diagnostic device ( 1 . 1* . 1** ) according to one of the preceding claims, characterized in that the diagnostic device ( 1 . 1* . 1** ) for creating 3D soft tissue images ( 42 ) is formed under evaluation of the detected X-radiation. Diagnostic device ( 1 . 1* . 1** ) according to one of the preceding claims, characterized in that the nuclear medical examination is designed as a SPECT examination and the radiographic examination as a CT-like examination and / or as a 3D X-ray examination. Diagnostic device ( 1 . 1* . 1** ) according to one of the preceding claims, characterized by a control and evaluation device ( 2 ) which supports the following operating modes: a) SPE or SPECT examination and / or b) X-ray examination and / or c) Combined and / or combinable nuclear medicine and radiographic examination, wherein a superposition of measurement data of a 2D-SPE examination with a 2D X-ray examination or a 3D SPECT examination with a 2D X-ray examination or a 2D-SPE examination with a 3D X-ray examination or with a 3D SPECT examination with a 3D X-ray examination. Diagnostic device ( 1 . 1* . 1** ) after one of the preceding claims, characterized by an integrated tumor treatment device ( 14 ). Diagnostic device ( 1 . 1* . 1** ) according to one of the preceding claims, characterized by a motion sensor system ( 23 . 39 . 40 ) for detecting patient movements and / or organ movements of the patient ( 5 ). Diagnostic device ( 1 . 1* . 1** ) according to one of the preceding claims, characterized by a feed system ( 7 ) for moving the patient through the measuring range ( 3 . 4 ) of the diagnostic device. Diagnostic device ( 1 . 1* . 1** ) according to claim 11, characterized by a position sensor for receiving the feed movement of the feed system. Diagnostic device ( 1 . 1* . 1** ) according to any one of the preceding claims, characterized in that for receiving the X-ray source ( 9 ) and / or the detector system ( 10 . 41 ) a C-arm construction ( 11 ) and / or two separate tripod legs and / or an annular gantry are provided. Diagnostic device according to one of the preceding claims, characterized by an integrated ablation device ( 18 ). Diagnostic device ( 1 . 1* . 1** ) according to one of the preceding claims, characterized in that measurement data of the nuclear medicine examination and the radiographic examination are offset in time and / or alternately readable and / or read out. Diagnostic method for combined and / or combinable radiographic and nuclear medical examinations using The diagnostic device according to any one of claims 1 to 15. The diagnostic method of claim 16, wherein the nuclear medicine Investigation is designed as a soft tissue tissue X-ray examination. A diagnostic method according to claim 16 or 17, wherein a 3D pre-recording of the patient in a separate X-ray computed tomography and / or a separate MRI magnetic resonance imaging device made and is fused with the measurement data of the diagnostic device.